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Mindfulness Training Offered In-person and in a Virtual World—Weekly Self-reports of Stress, Energy, Pain, and Sleepiness among US Military Active Duty and Veteran Personnel

Abstract

Objectives

The purpose of this paper is to present research findings on the effects of mindfulness meditation training on four weekly self-report measures among three groups: those receiving training delivered in-person (M-IP) or in a virtual world (M-VW), and a waitlist control group (WLC).

Methods

Participants (n = 191) were US military active duty service members and veterans. The M-IP and M-VW groups reported their stress, energy, pain, and sleepiness before/after each mindfulness training class, while the control group answered the same questions once a week for the 8-week duration of training.

Results

The M-IP and M-VW groups showed greater reductions in stress over the 8 weeks than the control group (1.70, 0.80, and 0.30 points, respectively; p = .028). Meaningful improvements (> 20%) pre- to post-training were seen for stress, pain, and sleepiness in the M-IP group, for pain only in the VW group, and for none in the WLC group. Those experiencing high levels of stress or pain before training experienced reductions in their stress or pain post mindfulness training, while those with lower initial levels did not (p < .001). Within class improvements were seen for both intervention groups; however, improvements were greater for those attending M-IP for energy, pain, and sleepiness (p < .034).

Conclusions

In-person mindfulness training yielded statistically and meaningfully superior results; however, both IP and VW delivery methods were effective in reducing stress among healthy US military active duty and veteran participants. Mindfulness was particularly helpful for those experiencing initially high levels of stress or pain.

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References

  1. American Thoracic Society (2018). Retrieved June 1, 2018, from http://www.thoracic.org/members/assemblies/assemblies/srn/questionaires/sss.php.

  2. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. https://doi.org/10.1093/clipsy.bpg015.

    Article  Google Scholar 

  3. Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 68(7), 755–765. https://doi.org/10.1002/jclp.21865.

    Article  PubMed  Google Scholar 

  4. Black, D. S., O'Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Internal Medicine, 175(4), 494–501. https://doi.org/10.1001/jamainternmed.2014.8081.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brand, S., Holsboer-Trachsler, E., Naranjo, J. R., & Schmidt, S. (2012). Influence of mindfulness practice on cortisol and sleep in long-term and short-term meditators. Neuropsychobiology, 65, 109–118. https://doi.org/10.1159/000330362.

    Article  PubMed  Google Scholar 

  6. Caddick, N., Cullen, H., Clarke, A., Fossey, M., Hill, M., McGill, G., et al. (2018). Ageing, limb-loss, and military veterans: A systematic review of the literature. Ageing and Society, 1–29. https://doi.org/10.1017/s0144686x18000119.

  7. Carlson, L. E., Speca, M., Faris, P., & Patel, K. D. (2007). One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21(8), 1038–1049. https://doi.org/10.1016/j.bbi.2007.04.002.

    Article  PubMed  Google Scholar 

  8. Chokroverty, S., Allen, R. P., Walters, A. S., & Montagna, P. (Eds.). (2013). Sleep and movement disorders. Oxford: Oxford University Press. https://doi.org/10.1093/med/9780199682003.001.0001.

    Book  Google Scholar 

  9. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.20982/tqmp.03.2.p079.

    Article  PubMed  Google Scholar 

  10. Creswell, J. D., & Lindsay, E. K. (2014). How does mindfulness training affect health? A mindfulness stress buffering account. Current Directions in Psychological Science, 23(6), 401–407. https://doi.org/10.1177/0963721414547415.

    Article  Google Scholar 

  11. Dahl, J., & Lundgren, T. (2006). Acceptance and commitment therapy (ACT) in the treatment of chronic pain. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: A clinician's guide to evidence base and applications (pp. 285–308). New York: Elsevier. https://doi.org/10.1016/b978-0-12-088519-0.x5000-x.

    Chapter  Google Scholar 

  12. Downie, W. W., Leatham, P. A., Rhind, V. M., Wright, V., Branco, J. A., & Anderson, J. A. (1978). Studies with pain rating scales. Annals of the Rheumatic Diseases, 37(4), 378–381. https://doi.org/10.1136/ard.37.4.378.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Erdfelder, E., Franz, F., & Buchner, A. (1996). GPOWER: A general power analysis program. Behavior Research Methods, Instruments, and Computers, 28(1), 1–11. https://doi.org/10.3758/bf03203630.

    Article  Google Scholar 

  14. Ferraz, M. B., Quaresma, M. R., Aquino, L. R., Atra, E., Tugwell, P., & Goldsmith, C. H. (1990). Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. Journal of Rheumatology, 17(8), 1022–1024.

    PubMed  Google Scholar 

  15. Frank, J. L., Reibel, D., Broderick, P., Cantrell, T., & Metz, S. (2013). The effectiveness of mindfulness-based stress reduction on educator stress and well-being: Results from a pilot study. Mindfulness, 6(2), 208–216. https://doi.org/10.1007/s12671-013-0246-2.

    Article  Google Scholar 

  16. Greer, T. W. (2017). Career development for women veterans. Advances in Developing Human Resources, 19, 54–65. https://doi.org/10.1177/1523422316682737.

    Article  Google Scholar 

  17. Gross, C. R., Kreitzer, M. J., Reilly-Spong, M., Wall, M., Winbush, N. Y., Patterson, R., Mahowald, M., & Cramer-Bornemann, M. (2011). Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomniaa: A randomized controlled clinical trial. Explore, 7(2), 76–87. https://doi.org/10.1016/j.explore.2010.12.003.

    Article  PubMed  Google Scholar 

  18. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35–43. https://doi.org/10.1016/s0022-3999(03)00573-7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Henriksson, J., Wasara, E., & Rönnlund, M. (2016). Effects of eight-week-web-based mindfulness training on pain intensity, pain acceptance, and life satisfaction in individuals with chronic pain. Psychological Reports, 119(3), 586–607. https://doi.org/10.1177/0033294116675086.

    Article  PubMed  Google Scholar 

  20. Herscovitch, J., & Broughton, R. (1981). Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep, 4(1), 83–92. https://doi.org/10.1093/sleep/4.1.83.

    Article  PubMed  Google Scholar 

  21. Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S … Maglione, M. A. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199–213. https://doi.org/10.1007/s12160-016-9844-2.

  22. Hoddes, E., Zarcone, V., Smythe, H., Phillips, R., & Dement, W. C. (1973). Quantification of sleepiness: A new approach. Psychophysiology, 10(4), 431–436. https://doi.org/10.1111/j.1469-8986.1973.tb00801.x.

    Article  PubMed  Google Scholar 

  23. Jha, A. P., Morrison, A. B., Drainer-Best, J., Parker, S., Rostrup, N., & Stanley, E. A. (2015). Minds "at attention": Mindfulness training curbs attentional lapses in military cohorts. PLoS One, 10(2), 1–19. https://doi.org/10.1371/journal.pone.0116889.

    Article  Google Scholar 

  24. Johnson, D. C., Thom, N. J., Stanley, E. A., Haase, L., Simmons, A. N., Shih, P. B., . . . Paulus, M. P. (2014). Modifying resilience mechanisms in at-risk individuals: A controlled study of mindfulness training in marines preparing for deployment. The American Journal of Psychiatry, 171(8), 844–853. doi: https://doi.org/10.1176/appi.ajp.2014.13040502.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kabat-Zinn, J. (2013). Full Catastrophe Living, revised edition: How to Cope with Stress, Pain and Illness using Mindfulness Meditation. Hachette: Bantam Books.

    Google Scholar 

  26. Kabat-Zinn, J., & Chapman-Waldrop, A. (1988). Compliance with an outpatient stress reduction program: Rates and predictors of program completion. Journal of Behavioral Medicine, 11(4), 333–352. https://doi.org/10.1007/bf00844934.

    Article  PubMed  Google Scholar 

  27. Kearney, D. J., Simpson, T. L., Malte, C. A., Felleman, B., Martinez, M. E., & Hunt, S. C. (2016). Mindfulness-based stress reduction in addition to usual care is associated with improvements in pain, fatigue and cognitive failures among veterans with gulf war illness. The American Journal of Medicine, 129(2), 204–214. https://doi.org/10.1016/j.amjmed.2015.09.015.

    Article  PubMed  Google Scholar 

  28. Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78, 519–528. https://doi.org/10.1016/j.jpsychores.2015.03.009.

    Article  PubMed  Google Scholar 

  29. Kirchner, J. E., Farmer, M. S., Shue, V. M., Blevins, D., & Sullivan, G. (2011). Partnering with communities to address the mental health needs of rural veterans. The Journal of Rural Health, 27(4), 416–424. https://doi.org/10.1111/j.1748-0361.2011.00362.x.

    Article  PubMed  Google Scholar 

  30. Kover, S. T., & Atwood, A. K. (2013). Establishing equivalence: Methodological progress in group-matching design and analysis. American Journal of Intellectual Developmental Disabilities, 118(1), 3–15. https://doi.org/10.1352/1944-7558-118.1.3.

    Article  Google Scholar 

  31. Lengacher, C. A., Johnson-Mallard, V., Post-White, J., Moscoso, M. S., Jacobsen, P. B., Klein, T. W … Kip, K. E. (2009). Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, 18(12), 1261–1272. https://doi.org/10.1002/pon.1529.

  32. Liu, B., & Rice, V. J. (2018). Characteristics of United States military personnel and veterans who completed mindfulness training. In V. Duffy & N. Lightner (Eds.), Advances in human factors and ergonomics in healthcare and medical devices (pp. 22–32). New York: Springer. https://doi.org/10.1007/978-3-319-60483-1_3.

    Chapter  Google Scholar 

  33. Martinez, M. E., Kearney, D. J., Simpson, T., Felleman, B. I., Bernardi, N., & Sayre, G. (2015). Challenges to enrollment and participation in mindfulness-based stress reduction among veterans: A qualitative study. The Journal of Alternative and Complementary Medicine, 21(7), 1–13. https://doi.org/10.1089/acm.2014.0324.

    Article  Google Scholar 

  34. Meland, A., Ishimatsu, K., Pensgaard, A. M., Wagstaff, A., Fonne, V., Garde, A. H., & Harris, A. (2015). Impact of mindfulness training on physiological measures of stress and objective measures of attention control in a military helicopter unit. The International Journal of Aviation Psychology, 25(3–4), 191–208. https://doi.org/10.1080/10508414.2015.1162639.

    Article  PubMed  Google Scholar 

  35. Mobbs, M. C., & Bonanno, G. A. (2018). Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans. Clinical Psychology Review, 59, 137–144. https://doi.org/10.1016/j.cpr.2017.11.007.

    Article  PubMed  Google Scholar 

  36. Morledge, T. J., Allexandre, D., Fox, E., Fu, A. Z., Higashi, M. K., Kruzikas, D. T., et al. (2013). Feasibility of an online mindfulness program for stress management—A randomized, controlled trial. Annals of Behavioral Medicine, 46(2), 137–148. https://doi.org/10.1007/s12160-013-9490-x.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rand Corporation. (2008). In Rand Corporation (Ed.), Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica.

  38. Rice, V. J., Boykin, G. L., Overby, C. R., Jeter, A., & Villarreal, J. (2018a). A pilot study evaluating the utility, acceptability, and feasibility of an abbreviated mindfulness meditation program before and during Army warfighting training. In V. Duffy & N. Lightner (Eds.), Advances in human factors and ergonomics in healthcare and medical devices (pp. 53–63). New York: Springer International. https://doi.org/10.1007/978-3-319-60483-1_6.

    Chapter  Google Scholar 

  39. Rice, V. J., Liu, B., & Schroeder, P. J. (2018b). Impact of in-person and virtual world mindfulness training on symptoms of posttraumatic stress disorder and attention deficit and hyperactivity disorder. Military Medicine, 183, 413–420. https://doi.org/10.1093/milmed/usx227.

    Article  PubMed  Google Scholar 

  40. Rice, V. J., Tree, R., Boykin, G., Alfred, P., & Schroeder, P. J. (2018c). Trust in automation among volunteers participating in a virtual world telehealth mindfulness meditation training program. In D. Cassenti (Ed.), Advances in human factors in simulation and modeling (pp. 151–160). New York: Springer International. https://doi.org/10.1007/978-3-319-94223-0_14.

    Chapter  Google Scholar 

  41. Serpa, S. J., Taylor, S. L., & Tillisch, K. (2014). Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Medical Care, 52, S19–S24. https://doi.org/10.1097/mlr.0000000000000202.

    Article  PubMed  Google Scholar 

  42. Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress managment intervention for healthy individuals. Journal of Evidence-Based Complementary & Alternative Medicine, 19(4), 271–286. https://doi.org/10.1177/2156587214543143.

    Article  Google Scholar 

  43. Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37(1), 144–162. https://doi.org/10.1093/epirev/mxu012.

    Article  PubMed  Google Scholar 

  44. Smith, B. W., Shelley, B. M., Dalen, J., Wiggins, K., Tooley, E., & Bernard, J. (2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral based stress reduction. Journal of Alternative and Complementary Medicine, 14(3), 251–258. https://doi.org/10.1089/acm.2007.0641.

    Article  PubMed  Google Scholar 

  45. Song, Y., & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress, and mindfulness in Korean nursing students. Nurse Education Today, 35(1), 86–90. https://doi.org/10.1016/j.nedt.2014.06.010.

    Article  PubMed  Google Scholar 

  46. Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62(5), 613–622. https://doi.org/10.1097/00006842-200009000-00004.

    Article  PubMed  Google Scholar 

  47. Stanley, E. A., & Jha, A. P. (2009). Mind fitness and mental amor: Enhancing performance and building warrior resilience. Joint Force Quarterly, 55(4), 144–151.

    Google Scholar 

  48. Stanley, E. A., Schaldach, J. M., Kiyonaga, A., & Jha, A. P. (2011). Mindfulness-based mind fitness training: A case study of a high-stress predeployment military cohort. Cognitive and Behavioral Practice, 18(4), 566–576. https://doi.org/10.1016/j.cbpra.2010.08.002.

    Article  Google Scholar 

  49. Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67(6), 614–623. https://doi.org/10.1001/archgenpsychiatry.2010.54.

    Article  PubMed  Google Scholar 

  50. Van der Riet, P., Rossiter, R., Kirby, D., Dluzewska, T., & Harmon, C. (2015). Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned. Nurse Education Today, 35, 44–49. https://doi.org/10.1016/j.nedt.2014.05.003.

    Article  PubMed  Google Scholar 

  51. Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24–31. https://doi.org/10.1037/2326-4500.1.s.15.

    Article  Google Scholar 

  52. Wisner, B. L., Krugh, M. E., Ausbrooks, A., Russell, A., Chavkin, N. F., & Selber, K. (2014). An exploratory study of the benefits of a mindfulness skills group for student veterans. Social Work in Mental Health, 13(2), 128–144. https://doi.org/10.1080/15332985.2014.972009.

    Article  Google Scholar 

  53. Zinzow, H. M., Britt, T. W., McFadden, A. C., Burnette, C. M., & Gillispie, S. (2012). Connecting active duty and returning veterans to mental health treatment: Interventions and treatment adaptations that may reduce barriers to care. Clinical Psychology Review, 32(8), 741–753. https://doi.org/10.1016/j.cpr.2012.09.002.

    Article  PubMed  Google Scholar 

  54. Zinzow, H. M., Britt, T. W., Pury, C. L., Raymond, M. A., McFadden, A. C., & Burnette, C. M. (2013). Barriers and facilitators of mental health treatment seeking among active-duty army personnel. Military Psychology, 25(5), 514–535. https://doi.org/10.1037/mil0000015.

    Article  Google Scholar 

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Acknowledgements

We acknowledge the US active duty and veteran service members who chose to volunteer their time to participate in this study. We also thank the creators of the virtual world second life environment and programs, Jackie Morie and All These Worlds, Inc.; our virtual world instructors Dr. Steve Hickman and Allan Goldstein, and colleagues Gary Boykin, Angela Jeter, Jessica Villarreal, Cory Overby, Leah Enders, and Mariah Tree for their integral assistance with this research.

Disclaimer

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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Contributions

VJR: designed and executed the study, served as the PI, and wrote the paper. BL: contributed to the initial data analysis and writing the paper. SCA: analyzed the data and wrote the results. PJS: collaborated in the writing and editing of the final manuscript.

Corresponding author

Correspondence to Valerie J. Rice.

Ethics declarations

The study was approved by the San Antonio Military Medical Center Institutional Review Board and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. All of the participants provided their written informed consent before participating in the study.

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The authors declare that they have no conflict of interest.

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Rice, V.J., Liu, B., Allison, S.C. et al. Mindfulness Training Offered In-person and in a Virtual World—Weekly Self-reports of Stress, Energy, Pain, and Sleepiness among US Military Active Duty and Veteran Personnel. Mindfulness 10, 1815–1827 (2019). https://doi.org/10.1007/s12671-019-01129-3

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Keywords

  • MBSR
  • Mindfulness meditation
  • Stress
  • Pain
  • Military personnel